Journal of the Formosan Medical Association最新文献

Background: Emphasis on primary health care (PHC) is the most efficient and economical approach to achieving universal health coverage, and should serve as its foundation. The aim of the study is to examine academic publications from 2011 to 2023 in the Asia-Pacific region (APR) using the Web of Science (WoS) subject category of PHC.

Methods: Academic papers in the WoS PHC category published in the APR from 2011 to 2023 were retrieved and analyzed, including papers published in the Science Citation Index-Expanded and the Social Science Citation Index.

Results: A total of 5172 papers were published in the WoS PHC category from APR onwards. The annual number of publications and their citations increased from 2011 to 2023. Australia led PHC publications in the APR with 3918 publications (75.75% of APR regional output). New Zealand had the highest number of citations per paper (14.54) and the highest mean impact factor (3.25 ± 1.70). Publications in the WoS PHC category also covered a wide range of topics, including Medicine General Internal (70.86%), Health Care Sciences Services (18.10%), Health Policy Services (17.67%), and Public Environmental Occupational Health (17.67%), demonstrating the breadth of PHC research.

Conclusion: The annual number of publications and their citations in the WoS PHC category from the APR increased from 2011 to 2023. Australia and New Zealand have a significant presence in the PHC publications in the APR.

Arterial hypertension is the most important modifiable risk factor for cardiovascular disease and a leading cause of death. The incidence of hypertension increases with age, with a lifetime risk of more than 90% for elderly individuals. With the growth in the absolute numbers and proportion of the elderly population worldwide, the economic impact and burden on healthcare systems due to elderly hypertension continue to rise. However, inconsistencies in the definition of elderly hypertension in different guidelines and the controversial results of various clinical trials underscore the importance of determining the consensus of management for elderly hypertension. Therefore, to clarify the current situation, this article discusses the definition, prevalence, and economic impacts of elderly hypertension.

Purpose: This study investigated whether Fibrosis-4 (FIB-4) score and its change can serve as predictors of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C (CHC) infection receiving direct-acting antivirals (DAAs).

Methods: This study identified 9679 patients who completed DAA treatment and achieved sustained virologic response (SVR) from the Taiwan Nationwide Real-World HCV Registry Program, and their risk of HCC was analyzed.

Results: Multivariable Cox regression analyses identified diabetes mellitus (DM), alpha-fetoprotein (AFP) level, and FIB-4 score as independent predictors of HCC in both Model 1 (baseline) and Model 2 (SVR). Change in FIB-4 score (△FIB-4) of < -0.9086 from baseline to SVR achievement was a significant predictor of HCC only in Model 2 (SVR). In Model 2 (SVR), DM (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.04-2.26, p = 0.033), FIB-4 score (≥3.25 vs. <3.25; HR: 2.40, 95% CI: 1.63-3.53, p < 0.001), △FIB-4 (greater reduction: <-0.9086 vs. smaller reduction: ≥-0.9086; HR: 1.85, 95% CI: 1.25-2.74, p = 0.002), and AFP level (≥20 vs. <20 ng/mL; HR: 16.40, 95% CI: 9.16-29.36, p < 0.001) were significant predictors of HCC. At 3 years, the cumulative HCC incidence was 10.67% in patients with an FIB-4 score of ≥3.25 upon achieving SVR and △FIB-4 of < -0.9086 and 1.72% in those with an FIB-4 score of <3.25 upon achieving SVR and △FIB-4 of ≥ -0.9086.

Conclusions: Posttreatment FIB-4 score and its change from baseline can be used to stratify HCC risk in patients with CHC receiving DAAs.

Background: Piriformis syndrome (PS) is a condition that causes low back pain. Ultrasound-guided injection (USI) has become a popular option for diagnostic block and treatment. Extracorporeal shockwave therapy (ESWT) is widely used for treating musculoskeletal diseases. However, few studies have compared the therapeutic efficacy of local steroid injections and ESWT.

Objectives: To compare the therapeutic efficacy of local corticosteroid injections and ESWT against PS.

Methods: This prospective randomized controlled trial enrolled 70 patients, who were randomly divided into two groups: the ESWT and USI groups. The ESWT group was subjected to one session of ESWT, and the USI group received one USI. Patients in both groups performed home-based stretching exercises. Evaluations were conducted at baseline and 1 and 5 weeks after the intervention. The outcomes included the patients' pain scores on a visual analog scale (VAS), Oswestry Disability Index (ODI), hip range of motion, side effects, and self-evaluation data.

Results: The groups did not vary significantly in terms of demographics. Significant time effects were observed in both groups, indicating post-treatment improvements. Furthermore, significant group effects were discovered in ODI and VAS pain scores. However, determining the superiority of one treatment over the other was challenging because of significant pretreatment differences between the groups in terms of ODI and VAS pain scores. However, no significant between-group difference was noted in the improvement rate.

Conclusions: ESWT and USI appear to be effective in the treatment of PS. The levels of efficacy of the two treatment approaches may be similar.

Clinical trial registration number: NCT04684537.

Background: To evaluate the correlation between atrial fibrillation (AF) burden and two-dimensional LA (left atrium) longitudinal reservoir strain (LARS) to explore the potential clinical utility of this novel parameter in patients with AF.

Methods: This cross-sectional study was conducted at the cardiac electrophysiology clinic of a tertiary centre by consecutively enrolling patients with non-valvular AF. The AF burden was evaluated using 14-day patch-based electrocardiography and defined as the percentage of time spent in AF during a 14-day monitoring period. High and low AF burdens were defined based on the median 14-day AF burden. Echocardiographic measurements, including the longitudinal strain of the LA, were performed in all patients.

Results: Among 267 patients, LARS was successfully performed in 221 (age 63 ± 11 years, male 71%, paroxysmal AF 71%). After adjusting for age, diabetes mellitus, congestive heart failure, estimated glomerular filtration rate, low-density lipoprotein level, left ventricular ejection fraction, LA dimension, and LA volume in multivariable linear regression analysis, low LARS remained a significant predictor of AF burden in addition to N-terminal pro-B-type natriuretic peptide and sex. Receiver operating curve analysis demonstrated that the best cut-off value for LARS to predict high AF burden (above median 10.49%) was 21.5%, with 75% sensitivity and 83% specificity.

Conclusions: LARS is associated with the AF burden in patients with AF. Further studies are needed to determine the role of routine LARS measurements in such patients.

Purpose: To evaluate whether animation-assisted learning (AAL) enhances caregiver's knowledge of anticipatory guidance (AG) for children and determine the influence of the socioeconomic status during a well-child clinical visit.

Methods: We prospectively enrolled caregivers who presented for well-child checkups at a tertiary care center. Participants completed a pre-test, watched a 25-min animation on specific AG topics, and then completed a post-test. We collected information on the caregivers' gender, parity number, educational level, age, and employment status and then analyzed test accuracy relative to select socio-demographic factors.

Results: We enrolled 150 caregivers (75 in the ≤3-month group, and 75 in the >3-month-to-7-year group). The pre- and post-AAL accuracy rates were 68.7% ± 14.5% vs. 88.2% ± 9.9% for the ≤3-month and 75.9% ± 13.1% vs. 92.3% ± 10.0% for the >3-month-to-7-year groups. Women, non-primipara caregivers, and college graduates in the ≤3-month group had better pre-test accuracy than their counterparts (p = 0.002, 0.002, and 0.004, respectively). Irrespective of socio-demographic factors, all caregivers demonstrated significantly improved AG knowledge post-AAL. Furthermore, college graduates or unemployed caregivers in the ≤3-month group showed improvements with AAL (p = 0.001 and 0.006, respectively).

Conclusions: Caregiver's knowledge level further improved post-AAL regardless of their socio-demographic backgrounds, highlighting AAL's effectiveness across diverse populations. The most substantial improvements were observed among higher-educated or unemployed caregivers with infants aged ≤3 months.